Select Committee on Health Third Report


"The evidence is quite plain—outbreaks of gonorrhoea and syphilis locally—high levels of teenage pregnancy and chlamydia. How much more evidence is needed to convince those who can make changes that the sexual health of the population is deteriorating? I was able to offer a better Sexually Transmitted Infections service to local people when I took up my post ten years ago."

Helen Lacey

One rather demoralised full time (100% NHS) consultant in Genito-urinary medicine.[1]

1. No area of public health in England has suffered a more dramatic and widespread decline in recent years than sexual health. Around one in ten sexually active young women (and many men) in England are infected with chlamydia, a sexually transmitted infection which, if left untreated, can lead to infertility. Syphilis, which had appeared to be disappearing from the population in England, has witnessed a 500% increase in the last six years. Gonorrhoea rates have also spiralled, almost doubling in the same period. HIV diagnoses, on one estimate, exceeded 6,000 cases in the last year, the highest recorded in England.

2. What confronts these armies of disease is one of the poorest-resourced, most stretched and least well-staffed areas of the NHS. One after another of the memoranda we received attested to the pressures faced by genito-urinary medicine (GUM). We were told that long waiting lists had replaced open access; that where open access remained in place hundreds of patients a week were now turned away; we were also told that premises were often dilapidated and unwelcoming; it was repeatedly suggested to us that moves to devolve more treatment to primary care would be unlikely to succeed, given the other competing pressures on services. Although in our visits we saw some excellent facilities and work being done on sexual health, these accounts of pressures were amply borne out by visits we undertook to major GUM clinics, where staff were expected to work in the most rudimentary conditions. Waiting lists stretched to eight weeks in the case of Manchester, while at Bristol, where the appointment system had been abandoned in favour of telephone bookings made on the day, some 400 people are being turned away each week. Those who are successful are treated in a Portacabin, a building which has been condemned.

3. As well as this burden of disease, Britain has the unwelcome distinction of recording the highest rates of teenage pregnancy in Europe, lagging behind only the USA in world rates amongst industrialised nations.[2] Indeed, rates of teenage pregnancy in the UK are around five times as high as those found in the Netherlands, Sweden, Switzerland or Italy.

4. Data from the National Survey of Attitudes and Lifestyles (see below, paragraph 70) suggest that the explosion in sexually transmitted infections has been facilitated by far-reaching changes in sexual behaviour over the last ten years, with both men and women reporting higher numbers of partners, and earlier ages at first sexual intercourse, together with increases in unsafe sexual practices.

5. It was in the context of these most worrying and depressing trends for STIs, HIV/AIDS and unwanted pregnancy that the Department of Health (the Department) in July 2001 published England's first ever strategy to tackle sexual health, Better Prevention, Better Services, Better Sexual Health: The National Strategy for Sexual Health and HIV (the Strategy). Our inquiry took as its basis an analysis of that strategy. While we have some reservations about some of the detail in the Strategy (and indeed about areas where there is scant detail) we regard as entirely commendable the decision of the Government to produce the Strategy. We would like to see measures going well beyond what it proposes, but would want to acknowledge that the Strategy represents an excellent starting point and a foundation which can be developed.

6. We announced our intention to hold this inquiry on 30 April 2002 with the following terms of reference:

    The Committee will examine the effectiveness of the Government's strategy for sexual health in the context of the consultation document Better Prevention, Better Services, Better Sexual Health: The National Strategy for Sexual Health and HIV.

7. Our advisers in this inquiry were Professor Michael Adler, Royal Free and University College Medical School, Dr Anton Pozniak, Chelsea and Westminster Hospital and Helen Christophers, an independent consultant in sexual health promotion. We are lucky to enjoy the services of many excellent advisers but we would particularly like to record our gratitude to members of this team who made a tremendous input into our work, putting in many hours of service and always providing high quality advice in a technically demanding, sometimes emotive area.

8. We heard from 67 witnesses in the course of ten evidence sessions, between 26 June 2002 and 23 January 2003. These comprised Hazel Blears MP, Minister for Public Health and officials in the Department of Health; the Parliamentary Under Secretary of State for Young People and Learning, Department for Education and Skills (DfES), Mr Stephen Twigg, MP; clinicians with specialist knowledge in this area within primary and secondary care; family planning service providers; the Communicable Disease Surveillance Centre of the Public Health Laboratory Service (PHLS); other experts in the epidemiology of STIs and HIV/AIDS; various patient groups and charities; experts in sex and relationships education; Dr Muir Gray, Programme Director of the National Electronic Screening Library; the Family Education Trust; and, most importantly, a number of young people aged 15 to 21. We are grateful to all our witnesses for their evidence.

9. We received over 160 written submissions and these were invaluable to us in our work. Those submitting ranged from GUM consultants, to academic institutions, charities, members of the public, lobbying groups, Royal Colleges and pharmaceutical companies. These memoranda formed a valuable resource for us and we would like to thank those submitting evidence for the many thoughtful contributions we received.

10. In the course of our inquiry we undertook three visits within the United Kingdom. In November 2002 we visited Manchester and Bolton. At Manchester Royal Infirmary we met GUM consultants and other clinical staff, and public health and Strategic Health Authority representatives. We visited the Brook Advisory Centre in Manchester, where we heard about sexual health services for young people and about the financial difficulties encountered by those trying to provide such services through the voluntary sector. Health promotion specialists based at Bolton Primary Care Trust shared with us examples of best practice with regard to the promotion of sexual health through targeted intervention and outreach work with off-street sex workers. We also met representatives from Manchester Young People's Council who talked to us about Sex and Relationships Education in schools and about their concerns relating to sexual health issues and the media. A note on this meeting is appended to our report.

11. In December 2002 we visited the Lighthouse King's Centre in Camberwell, London. We heard about the model of integrated care developed by the Caldecot Centre (King's Hospital GUM clinic) and by the Terrence Higgins Trust to provide sexual health services and a wide range of other support services to those living with and those affected by HIV.

12. In February 2003 we visited Bristol, Paignton and Exeter. We heard from staff at the South Bristol NHS Walk-in Centre and met clinical and managerial leads at the premises of the Milne Centre for Sexual Health, Bristol Royal Infirmary. In Exeter we heard from single-handed clinicians who provide services for large populations in rural areas in the South West of England, and from representatives of the A PAUSE Sex and Relationships Education project. At Paignton Community College we saw the Teenage Information Centre-Teenage Advice Centre or Tic Tac project. We met the health and youth work professionals who staff the Centre (a self-contained bungalow on the site of the college), representatives of the college management, and students at the college.

13. Since sexual health is also an area where there is EU competence, because it is an aspect of public health, we visited Brussels in July 2002 to hold discussions with Health Commissioner David Byrne and his officials. We also met representatives of the International Planned Parenthood Foundation Network. These meetings helped us to gain a better understanding of the European context of our inquiry. We were able to see just how poorly England fared in terms of teenage pregnancy rates. However, we also learned that STIs were rapidly rising across most of Europe; and in addition it was impressed on us that the relatively recent rapid growth in figures for HIV/AIDS in Central and Eastern Europe would be likely to have an impact on Western European countries in the near future.

14. In December 2002 we visited Sweden and the Netherlands. In Sweden we held meetings with representatives from Youth Health Centres and the staff of Rudbeck Upper Secondary school in Stockholm, the Swedish Institute for Infectious Disease Control, National Institute for Public Health, the Sexual Health Clinic at South Stockholm General Hospital, the Swedish Social Ministry and the Health and Welfare Committee at the Swedish Parliament. In the Netherlands we held meetings with representatives from the International Affairs Department, Ministry of Health, Welfare and Sport, the staff of AMOC clinic for sex workers, the HIV Foundation, the Municipal Health Centre, the Institute for Prostitution Studies, the Prevention and Health division of the Netherlands Institute of Applied Geo-science, and the Netherlands Institute for Health Promotion and Disease Prevention. These meetings provided an opportunity for us to see at first hand the different approaches to sexual health taken by two socio-economically comparable countries, and in particular to see examples of good practice in terms of sexual health services for young people and of infectious disease control. However, our visits to Sweden and the Netherlands also showed us that the public health problems caused by sexual ill health are increasing rapidly even in countries where such good practice is found.

1   Ev 330 Back

2   International Planned Parenthood Foundation, European Network, Annual Report 2001, (Brussels, 2002), p 6 Back

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